DISABIILTY BENEFITS FOR SEIZURE DISORDERS

We frequently represent individuals with Epilepsy or seizures in the attempt to get Social Security disability benefits.

While a seizure disorder may certainly be disabling under Social Security's rules, this isn't always the case.  Social Security will evaluate the disorder based on it's nature (type of seizures), frequency and medical treatment.

Here is what you will need to be approved and paid:

• a diagnosis of epilepsy or other seizure disorder
• a detailed description of your typical seizure, including all pre- and post-seizure symptoms
• a statement from your doctor corroborating your account of the nature and frequency of your seizures
• a description of your seizures from a third-party witness
• a record indicating the frequency of your past seizures
• results of an EEG, and
• a detailed treatment history, including medications and other treatments that you’ve tried and your response to them. 

Social Security will want to see where the claimant has been taking anti-convulsant medications for at least 3 months.  A doctor should have reviewed the medication and adjusted the dosage in an attempt to control the seizures.  If the seizures continue to be frequent enough to interfere with sustaining regular, full-time work, benefits may be approved.

Besides medical care, the one thing that will help your case the most is a diary or written record of your seizure activity, kept by a third party who can document the type of seizures, what activity accompanies a seizure and how often they occur.  You can't just depend on doctors or emergency room records because by the time you get to the ER or doctor's office, the seizure has already long passed. Also, many people don't go to the doctor or ER every time they have a seizure.  Therefore, have a member of your family keep a detailed record of your seizures.


The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297

Free evaluations and consultations 

SOCIAL SECURITY JUSTICE - WEBSITE 

GOVERNMENT MAKES DISABILITY BENEFITS HARDER TO GET

For the past 20 years, the number of new Social Security disability applications has increased each year, causing the administration to warn that the trust fund which pays benefits will soon become insolvent.

Based on this fright, the government tightened the screws on Social Security disability benefits in several ways:

• making qualifying for Social Security disability insurance benefits more difficult
• making the application process more arduous and
• making the appeals process for rejected applications harder.
  
  The result has been dramatic.  Approval rates with judges fell from 62 percent to 42 percent.  Tens of thousands of appeals that once would have been approved are being denied.
  
  Very few applicants these days will even attempt a Social Security application, let alone an appeal, without legal representation.
  
  2018 saw some changes.  The number of new SSDI claims decreased for the first time in over twenty years.  It looks like new claims will fall again in 2019. This moves the insolvency crisis for the trust fund ahead by about ten years.
  
  Social Security benefits remain very difficult to get for most claimants.  Over two-thirds of applications will initially be denied.  These claimants must go through a rigorous appeal process, including an appearance before a US administrative law judge (ALJ) to have their applications reconsidered.  
  
  Social Security's definition of "disability" is very strict.  For most persons it means the inability to perform any kind of full-time work.  Claimants who retain the ability to work an unskilled, sedentary job (often at minimum wage) are found ineligible for disability benefits.  
  
  Claimants who are 50 or over may fare a little better, thanks to the "grid rules" or medical-vocational guidelines.  However, most of these older claimants will also be denied initially and will need to go through the appeal process before they can get benefits.
  
  _______________
  The Forsythe Firm
  Social Security Representatives
  7027 Old Madison Pike - Suite 108
  Huntsville, AL 35806
  CALL (256) 799-0297
  
  Free consultations 
  
  SOCIAL SECURITY JUSTICE - WEBSITE
  
   
  
   
  
   

DENIED DISABILITY BENEFITS? DON'T REAPPLY

Once the Social Security Administration has denied a disability claim, it's virtually useless to file a new application.  

The same people, in the same building, look at the new application and make the same decision again:  another denial.  What have you accomplished?  You wasted 5 more months.

What is the better option?  In most cases, the better option by far is to appeal the original denial.  It takes 30 minutes to file an appeal.

Why is the appeal a better option for you?

1.  It gets you out of the state agency (Disability Determination Service) which has a 75 percent denial rate.  An appeal moves you up the ladder to a federal administrative law judge (ALJ) who can give you a more thorough (and fair) hearing and render a totally new decision.

2.  The appeal preserves your rights, including back pay, under the original claim.  A new claim will nearly always lose some of your back pay along the way.

3.  Your odds of being approved are simply better at the appeal level--almost twice as high, in fact.

So don't spin your wheels by filing a new application.  Instead, file an appeal.

CAUTION:  You have 60 days by law to file an appeal on a denied claim.  No more.  That 60 days begins with the date on the denial letter.

SOCIAL SECURITY'S DEATH BENEFIT

When an insured worker dies, Social Security pays a one-time death benefit of $255.  That's all.

This is the same amount that was established in 1937 and it hasn't changed over the years.  It isn't expected to.

However, when an individual dies while receiving Social Security benefits, the surviving widow or widower may be eligible to get continuing survivor's benefits.  The general requirements are:  must have been married for at least 9 months prior to death, and the survivor must be at least 60 years old (50 if disabled).  Surviving children still in elementary or high school, and under age 19, may also get a benefit.

 

IS SOCIAL SECURITY ENOUGH WHEN THE WORST HAPPENS TO YOU?

Question:  Does Social Security pay enough when disability strikes and you can't work any more?

Answer:  No.

The average Social Security disability payment is $1,197 per month.  I don't need to tell you how hard it is to get by on that.  And, it may take months or years to get that benefit started.  Sad, but the simple truth!

So, what can you do now to protect yourself?  Here are some important things you should think about for your family:

1.  Buy or sign up for both short term and long term disability insurance at work.  Why?

• This insurance will pay you while you wait on Social Security.
• This insurance will pay you if Social Security denies your benefits.
• This insurance may pay you a higher benefit than Social Security.
• Short Term Disability (STD) may only pay a benefit for 3 to 6 months.  Be sure you have the Long Term Disability (STD), too.  Short term simply isn't enough protection.

2.  If your company doesn't offer disability insurance, get some on your own if you can.

But be careful what you buy.  There's a lot of junk products out there.  I don't recommend a disability plan that only covers accidents -- because most disability doesn't involve accidental causes.  Most disability cases are caused by disease, not accidents.  If you have an accidental insurance plan it excludes disability caused by cancer, heart attacks, migraine headaches, back trouble, surgery, etc.  It's cheap but often useless.

3.  Put away some savings if you can.  Resist the ever present temptation to spend the money for anything besides a true emergency. 

My firm specializes in help disabled workers get Social Security disability benefits.  You need to understand Social Security's limitations:  It's hard to get and it takes a really long time.  Be sure you have private disability insurance to fall back on.  If your employer offers it, sign up for it now!

Even if approved quickly, which is rare, Social Security does not pay the first 5 full months of disability.  So you are left on your own for 5 months.  In a really quick Social Security case that goes well, it will take 6 months to receive the first check.  Cover that with short-term and long-term disability at work.  It's a life saver!
_______
The Forsythe Firm
Representing Social Security Disability Clients
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297     

WHEN DOES SOCIAL SECURITY ELIGIBILITY END?

Like all other insurance programs, there is a date when your Social Security disability insurance expires.  You must prove to Social Security that your claim (disability) began before the insurance ended.

With SSDI, that expiration date is based on your work history.  This is called the Date Last Insured or DLI.  As a rule of thumb, you must have worked at least 5 out of the last 10 years to have a DLI that has not yet expired.  Since you can earn a maximum of 4 quarters of work coverage each year, 5 years of maximum work would earn 20 quarters of coverage.  The specific number of work credits required varies by age.  In short, you must have contributed to the Social Security trust fund through FICA payroll deductions to be covered.

A DLI in the past, known as a "remote DLI" can make your claim difficult to win.  This is because Social Security can only consider medical evidence prior to that date.  For example, if your DLI was 12/31/16, medical evidence after that date does not count.  If you are diagnosed with a new medical condition after your DLI, Social Security will not count it as evidence.

It is important to apply for SSDI benefits as soon as you feel you are unable to work a full-time job.  Delaying your application will only make the claim more difficult to win.  

While I'm here, let me state the basic rules to get SSDI benefits:

• Not currently working at substantial gainful activity.
• Have a severe medical impairment that has lasted, or is expected to last, for 12 straight months.
• Not able to work a full-time job now due to this impairment

Medical evidence is the key to being approved.  Social Security will require objective medical evidence of your impairment:  the nature of your impairment, when it began, its severity and how it limits your ability to do work-like activity.
_______________
Charles W. Forsythe
THE FORSYTHE FIRM
7027 Old Madison Pike - Suite 109
Huntsville, AL 35806

CALL (256) 799-0297

SOCIAL SECURITY JUSTICE - OUR WEBSITE 



 

"DON'T GIVE UP. APPLY AGAIN." THIS MAY BE REALLY BAD ADVICE!

Social Security denies up to 70 percent of disability applications.  Their denial letters are infamous.  

One of the remarks I hear and read when people discuss being denied benefits is this one:

"Don't give up.  Apply again."

In most situations, this is really, really bad advice.

Instead of applying again (and getting denied again), you probably need to file an appeal.

Here are 7 reasons that filing a new application after you have been denied is often a bad idea:

1).  Your new application goes back to the very same agency, in the very same building, that denied you the first time.

2)  The agency, called the Disability Determination Service or DDS, will use the same rules and the same evidence to consider your new application. 

3) Unless something is radically different about the new application, the same people look at the same evidence, apply the same faulty reasoning and make the same decision--another denial.  "We just denied this claim 30 days ago,what's it doing back on my desk?"

4)  The new application will probably waste an additional 3 to 5 months, while you are no closer to getting a benefit check that when you began.

5)  The new application will not protect the past due benefits you may be entitled to.  A new application literally starts over at the beginning and you lose all potential benefits under your original (first) application.  Bad idea for most folks.  (There are exceptions to all things).

6)  The 6th reason not to file a new claim is: You are stalled in a state bureaucratic system that has a dismal record of getting decisions right.  You need OUT of this state system and into the federal appeal system.  

(7) You are speeding toward your "date last insured" or DLI.  It's the date on which your coverage for Social Security disability expires.  Once it expires, it is gone.  New claims are difficult or impossible after this date.  Don't waste time. A proper appeal saves your original "protected filing date" and protects you even if your Date Last Insured occurs during the appeal.

So, what's the take away on this?

For most claimants, it's a waste of time to file a new claim.  Even if you could win the new claim, you have lost time and benefits that you won't recover.

It's much better in most cases to file an appeal and get your denied claim before an administrative law judge, where most Social Security disability claims get approved these days.

The appeal is usually better because:

A)  You may get back pay or retroactive benefits back to the original date of disability. 

B.  Someone will give you a fresh, new review of your claim without being prejudiced by the fact that you were once denied.

C.  You get to appear in person at your hearing and explain your situation and your case.  Best of all, you can bring along your attorney or legal advisor.

D.  The appeal gets you moving vertically up the ladder, not horizontally across the same tried and failed process.  Simply put, the appeal sends you off in a new, better direction, with a better chance.

Filing an appeal sounds like such a burdensome and complicated chore.  It isn't.  You can file it yourself by filling out a few forms available at the Social Security office.  (Winning the appeal is a lot more complicated than filing it).  You can get an attorney or disability advocate to fill out the appeal for you with no upfront charge.  This service will also come with a commitment to develop your case and help you with the appeal process and hearing.  

Talk to a professional before you listen to well meaning friends, neighbors or family members who tell you, "Don't give up.  Apply again."  

Here's the way I would say it.  

"Don't give up.  Appeal that denial."
________________
THE FORSYTHE FIRM
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297

Free consultations

SOCIAL SECURITY JUSTICE - WEBSITE 

 



 

DISABILITY BENEFITS FOR EPILEPSY OR SEIZURES

We frequently represent individuals with Epilepsy or seizures in the attempt to get Social Security disability benefits.

While a seizure disorder may certainly be disabling under Social Security's rules, this isn't always the case.  Social Security will evaluate the disorder based on it's nature (type of seizures), frequency and medical treatment.

Here is what you will need to be approved and paid:

• a diagnosis of epilepsy or other seizure disorder
• a detailed description of your typical seizure, including all pre- and post-seizure symptoms
• a statement from your doctor corroborating your account of the nature and frequency of your seizures
• a description of your seizures from a third-party witness
• a record indicating the frequency of your past seizures
• results of an EEG, and
• a detailed treatment history, including medications and other treatments that you’ve tried and your response to them. 

Social Security will want to see where the claimant has been taking anti-convulsant medications for at least 3 months.  A doctor should have reviewed the medication and adjusted the dosage in an attempt to control the seizures.  If the seizures continue to be frequent enough to interfere with sustaining regular, full-time work, benefits may be approved.

Besides medical care, the one thing that will help your case the most is a diary or written record of your seizure activity, kept by a third party who can document the type of seizures, what activity accompanies a seizure and how often they occur.  You can't just depend on doctors or emergency room records because by the time you get to the ER or doctor's office, the seizure has already long passed. Also, many people don't go to the doctor or ER every time they have a seizure.



The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297

Free evaluations and consultations

THE 5-STEP SEQUENTIAL EVALUATION PROCESS

When you apply for Social Security disability or SSI, the law requires that they use a five-step sequential process to determine if you qualify for benefits.

Each step must be determined in order.  If you fail step 1, you do not go on to step 2, etc.  

Here are the 5 steps in the consideration:

1.  Are you now working at substantial gainful activity?  (Are you earning at least $1,180 per month from work activity)?  This is a 2018 number; the amount changes annually.

2.  Do you have a serious and medically determinable impairment?

3.  Do you meet one of Social Security's published listings?  If so, you are approved here.  If not, you go on step 4.  At step 3, however, Social Security must determine what your residual functional limitation is.  In other words, what type of work, if any, are you still capable of doing? 

4.  Are you able to perform any of your past relevant work (meaning, any of the jobs you did during the past 15 years)?

5.  Finally, are there any jobs in the national economy that you can still perform?  This question applies primarily to persons under age 55 (sometimes for persons under 50).  Older workers probably won their case back at step 4.

------
So, if you are working full-time you will lose at step 1.  If you don't have a significant medical impairment, you lose at step 2.  If you are still able to perform one of your past jobs, you lose at step 4.  If you aren't able to perform any past work but could perform some other work, you lose at step 5.

Why is all this important?  Because it tells you exactly what kind of chance you have.  Also, it tells your attorney how to prepare and argue your case.  

There are facts in your case that you can't change.  As a friend of mine famously says, "It is what it is."  

However, the one gray area that can be argued about is your residual functional capacity.  How much, and what type, of work are you still able to do?  What do the grid rules dictate in terms of a decision?

Your case will depend (win or lose) on what your functional limitations are.

For example, you can stand and walk at least 6 hours out of an 8 hour day and can lift up to 50 pounds occasionally.  You may be able to perform medium exertion level work.

If you are limited to lifting no more than 10 pounds frequently and up to 20 pounds occasionally, you are limited to work in the light exertion level. 

If you are unable to lift 10 pounds occasionally, you can still perform work at the sedentary level.  Inability to lift even 10 pounds occasionally will prevent even sedentary work.

Lifting isn't the only thing considered.  Among many other important factors will be your ability to sit, stand, walk, bend, reach, grasp, or hold with your hands.  

Mental restrictions are also considered.  You might be found disabled because you can't remember or carry out simple instructions, cannot concentrate or focus long enough to do a job, or have other psychological limitations that won't let you sustain even simple full-time work.

If you're trying to figure out if you have a winnable Social Security case, you may want to speak to an experienced attorney or advocate.  Frankly, it's a little bit like putting together a complicated jig saw puzzle.  There are so many pieces!  Someone who has done this for a long time can give you a lot of guidance and may be able to help win your case.
__________________
The Forsythe Firm
Social Security Counselors
7027 Old Madison Pike NW
Suite 108
Huntsville, AL 35806
CALL US (256) 799-0297

SOCIAL SECURITY JUSTICE - WEBSITE 

 

Call one of our advocates for
experienced counsel about disability.
FREE CONSULTATIONS.
(256) 799-0297

"THE HELL OF APPLYING FOR GOVERNMENT BENEFITS"

A couple of years ago Laura Kwerel wrote an article in the Atlantic Monthly titled "The Hell of Applying for Government Benefits."  The link to the article is given below:

https://www.theatlantic.com/politics/archive/2016/06/social-security-administration/486410/ 

Ms. Kwerel had attempted to get Social Security benefits for her daughter.  She describes how the government bureaucracy battled her every step of the way.

Anyone considering applying for Social Security disability or SSI benefits should read this article first.

It explains why there is a huge national industry of lawyers who do nothing but help claimants applying for Social Security and other government benefits.

You may be told that you can do it yourself, you don't need a lawyer.  And while that is technically true, you must be prepared to spend countless hours entangled in frustrating bureaucratic red tape, complications, delays and confusing regulations.  If the system worked the way it ought to, lawyers or advocates would not be required.  But the system doesn't work that way.

The article by Laura Kwerel is sad but fascinating--worth reading by anyone who wants the real story of how difficult it is to deal with Social Security yourself.
_____________
THE FORSYTHE FIRM
Social Security Representation
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
(256) 799-0297
 

HOW SOCIAL SECURITY DISABILITY REALLY WORKS

Each day you work, the US government withholds a portion of your pay, called FICA tax.  This money goes into a special trust fund under your name and Social Security number.  When you retire or become disabled, money can be taken out of this fund to pay you a benefit.  In terms of a disability benefit, SSDI is really a government provided insurance policy against disability.

However, proving that you are disabled according to Social Security's rules can complex and difficult.  Their definition of disability is almost impossibly strict.  You may need legal assistance to prove "disability according to our rules" and get a benefit.

If you are under age 50, the standard for being disabled is:  You are not medically able to perform any full-time job that exists in the United States.  That includes unskilled sedentary jobs like ticket taker, parking garage attendant, etc., which usually pay minimum wage.

  The maximum benefit can be around $3,000 per month.  Your actual benefit will depend on your age and your average annual earnings.  If approved, you will also become eligible for Medicare insurance but must wait 29 months (from the beginning of disability) for Medicare coverage to begin.  Children or other dependents may also get a monthly benefit.

HOW TO FILE AND GET BENEFITS

1.  You file an application for disability benefits--a group of complicated forms consisting of about 200 questions.  You may file by going to a Social Security office (expect a long wait), by calling the Social Security office, or by getting an attorney or disability advocate to help you file.

Unless your medical case is very compelling and clear cut, there is a high probability that you will be denied on the first try.  Denials occur with almost three-fourths of applications in Alabama.

However, a denial is par-for-the-course.  It's not the end, just the beginning.  If you are denied, you are ready for Step 2 in the process, which most people will follow through with.  If you don't, you lose.

2.  You file a written appeal of your denial within 60 days.  This sends your case back to the Disability Determination Service or DDS--the agency that denied you in the first place.  The same agency, but a different person, will review your application again.  Alas, they issue a second denial in about 95 percent of cases at this level.  But you must do this to get to the next step.

3.  You appeal again and ask for a hearing before a US Administrative Law Judge (ALJ). 

A successful appeal hearing requires that someone do the following prior to the hearing:

• Obtain all medical records
• Read and analyze all the medical records
• Develop a strategy for meeting the regulations
• Determine if you meet a Listing or grid rule.
• Give the judge a written summary of the case (a brief)
• Prepare you, the claimant, for what to expect at the hearing
  
• Prepare to present the case in a clear, succinct manner to the judge.
  
• Prepare to question Social Secrity's experts who will testify at the hearing.
  
• Address any post hearing problems or requirements that come up.

View of a Typical Social Security Hearing

Your odds of winning at the hearing are much higher than they were with the original application, especially if the appeal is well prepared.  An attorney or representative who is experienced with Social Security cases will know how to prepare the case for the best chance to win your benefits.

You will not pay your representative any money upfront.  All work with be done on contingency.  A fee will become payable only if you win and only if you receive past due benefits. When that happens, the administrative law judge will authorize Social Security to withhold a small portion of your past due benefit to pay the representative directly.  All fees must be approved by the same judge who approved your benefits.  You are protected against high or unreasonable fees.

WHERE DO I START?

The easiest place to start is calling an experienced advocate who has handled hundreds of Social Security cases.  Often, a 15-minute phone call can analyze your case and give you a lot of direction on how to proceed.  If the representative believes that your cases has merit, he or she can help you file the paperwork for the next step. 

We think using a local representative is better.  Why deal with someone a thousand miles away?  Why go through a large, distant "call center" when you could call your representative directly, right here in Huntsville?
______________
Charles W. Forsythe
Social Security Disability Representation
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
"Across from Bridge Street"
CALL  (256) 799-0297 

  https://forsythefirm.wixsite.com/website

SOCIAL SECURITY EXERTION LEVELS: WHY THEY MATTER

One of the big things a Social Security decision maker must do is determine the claimant's capacity to perform different levels of work.  In other words, can he perform very light work or harder work?

Social Security considers 5 levels of work.

Very Heavy work.  This is very physical work which may require lifting 100 pounds or more.  Very few people can perform this work for 8 hours per day.

Heavy Work.  This requires lifting more than 50 pounds regularly and up to 100 pounds occasionally.

Medium Work requires lifting at least 25 pounds frequently and up to 50 pounds occasionally.

Light Work would require lifting more than 10 pounds frequently but no more than about 25 pounds occasionally.

Sedentary Work is the easiest.  It can be performed mostly from a seated position and may require standing/walking for only about 2 hours per day.  Sedentary work only requires lifting up to 10 pounds occasionally.

WHO DECIDES A CLAIMANT'S CAPACITY?

In a hearing, the administrative law judge will decide how much capacity the claimant has.  This is based primarily on a review of the medical records, although claimant testimony is taken into account IF supported by the medical record.

A doctor may provide his or her opinion about capacity.  That's why a claimant's attorney/representative may provide a form for the claimant's doctor to complete.  The form will ask about the patient's ability to sit, stand, walk, bend, kneel, lift, etc.  The purpose of this form is to help Social Security properly determine how much capacity for work the claimant has, in spite of his/her impairments.

WHAT IS THE REQUIRED STANDARD FOR APPROVAL?

If under the age of 50, claimants must show that they are restricted to less than sedentary work capacity.  In other words, they are not able to sit at least 6 hours out of an 8-hour day, to stand/walk at least 2 hours per 8-hour day, and cannot lift at least 10 pounds occasionally. This is why it is so difficult to get approved if you are below age 50.

Who Can Evaluate Your Case and Determine the Strength of Your Disability Claim?

An experienced attorney or disability advocate can review your claim and evaluate whether you meet the basic requirements of Social Security disability.

P.S.  If there are restrictions from mental impairments (depression, PTSD, anxiety, etc.), these are evaluated independent of exertion restrictions. 

WHY YOU NEED RECORDS FROM YOUR OWN DOCTOR?

In Social Security disability claims, it is infinitely better to have medical records from your own doctor(s).  

Decision makers want to see at least 12 months of recent medical treatment.  In cases where this treatment doesn't exist, Social Security may send you for a special consultative examination (CE), performed by a doctor under contract with Social Security to furnish these exams.

Maybe a  CE is better than no evidence at all, maybe not.  My experience is that consultative exams usually do not help get claims approved.

There are some things that your own doctor can provide that a consulting doctor cannot:

•   History of treatment; what has worked, what hasn't.
•  Medications and therapy that has been tried.
•  Response to treatment.
•  Prognosis - What course is your illness likely to take?
•  Opinion with regard to your physical/mental limitations.

If I had to list the Number One factor that helps claimants get approved for disability benefits, it would be an adequate medical record.  

Here are some further suggestions as you seek medical treatment, with regard to how the treatment may affect your chances with Social Security:

• Try to see a physician (MD or DO), or a Physician's Assistant (PA), as opposed to a nurse practitioner.  
• Follow doctor's orders (treatment plan) as closely as possible.
• Try to see your primary care doctor at least twice a year.
• Seek a specialist if you have a condition that requires it (for example, a cardiologist, orthopedic specialist, neurologist, etc.).
• If possible, get imaging studies or laboratory testing to verify the diagnosis and severity of your condition.  An MRI, CT scan or even a simple X-ray, in some cases, may be good as gold.

Remember, it's not about what a claimant says; it's about what he/she can PROVE.  So, one of the best things you can do is to see your doctor(s) regularly and get as much treatment and investigation of your medical condition as possible.
________________
Charles W. Forsythe
The Forsythe Firm
Social Security Disability Represention
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
"Across from Bridge Street"

FREE CONSULTATIONS:  (256) 799-0297

 
SOCIAL SECURITY JUSTICE 
 

DDS: THE DISABILITY DENIAL SERVICE. GET OUT OF THERE!

The official name for DDS is the Disability Determination Service.  But attorneys refer to them as the "Disability Denial Service."  That's because they deny such a huge percentage of claims at the initial, application level.  Their award rates are dismal.

DDS is the state agency which makes the initial decision on Social Security disability applications.  They will order your medical records, review them, determine if they support your claim and issue a decision.  There is a 75 percent chance you will be denied by this state agency.

By filing an appeal on the denial, however, you move your claim away from the state level and into the federal arena.  The appeal puts you in the Office of Hearings and Appeal, a strictly federal agency within Social Security.  It's a more productive place to be, although the waiting time can be quite lengthy (down to about 6 or 7 months now, less than it has been).

The appeal heads your claim toward a hearing with a US Administrative law judge. There are two advantages to the appeal forum vs. the application forum at DDS:

1.  You get an in-person hearing with a judge.**
2.  You get to take your attorney/representative to the hearing.

A vigorous appeal can be your best chance to get paid.  

Get a good representative for your appeal.  You will pay nothing unless you win and all fees are regulated by the Social Security Administration.

** Since the COVID-19 pandemic, all hearings are held via telephone conference call.  But your attorney can be on the line with you and ask the same questions.  No one knows when in-person hearings will resume.

___________
Charles W. Forsythe
Social Security Representation
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
PH. (256) 799-0297

Serving all of North Alabama and Middle Tennessee

https://forsythefirm.wixsite.com/website

THE LOGICAL APPROACH TO GETTING SSDI BENEFITS

Luck has very little to do with getting approved for a Social Security disability check.  Logic, law and the grid rules have a lot more to do with it.

Logic, in the sense that the case must make sense to the administrative law judge who handles your appeal.  (Forget about getting approved merely by filing an application; those days are gone--unless you have a terminal or catastrophic illness).  The narrative about why you can't work must make sense to the judge.  And judges think differently than claimants.  Believe me--they do.

Law, in the sense that no judge is going to pay a benefit unless the law directs it.  You basically have to show a judge that the federal regulations dictate that you qualify for benefits.  You meet all the rules, so the judge will be upholding the law when you are approved.  Short of this, no benefit will ever be paid.

Grid rules can help you if you are age 50 or over and have a physical or exertional impairment.  An exertional impairment is a physical impairment that restricts your ability to sit, stand, walk, lift or push/pull.  Grid rules do not apply to mental impairments.  The grids often make it much easier to prove disability for persons age 50 and over, especially those who are 55 or over.

I approach a disability appeal with a thorough fact finding session.  I want to know your medical background, your past work history, you education level and any doctor's opinion about your ability to perform specific work related activities.  Note:  It isn't enough for your doctor to make a general statement like, "This patient has heart trouble and is totally disabled and should not attempt to work."  While this sounds like it would do the trick, it will not because it violates one of Social Security's legal principles.  That principle says, "Only the Commissioner of Social Security may determine who is disabled."  It is not the doctor's role.  Therefore, this kind of testimony is not admissible.

We can provide forms to help your doctor give admissible testimony about your medical impairments--which Social Security may accept. 

Getting an SSDI claim approved is a lot like putting together a complicated legal jigsaw puzzle.  Piece by piece.  And only someone who has experience and skill in this area can be expected to do it well.

HOW TO DISABILITY REPRESENTATIVES GET PAID?

A representative can only charge you a fee if you win your case and recover some back pay (also called "past due benefits").  Social Security will withhold a percentage of your back pay--which cannot exceed 25 percent--and pay your representative directly.  Not all representatives are eligible for direct payment but those who have met stringent requirements are.  The Forsythe Firm is eligible for Direct Payment of Fees from Social Security.

If you don't win your case, or if you win but don't get any back pay, there is never a fee.  You will always keep 100% of your monthly benefits.

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THE FORSYTHE FIRM
Social Security Representation
7027 Old Madison Pike NW - Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

SOCIAL SECURITY JUSTICE (WEBSITE) 

"We handle nothing but Social Security cases."
 

SOCIAL SECURITY: AN INSURANCE BENEFIT, NOT AN ENTITLEMENT

HISTORY:  Congress passed the Social Security Act in 1935 as a pension program for elderly Americans, allowing them to draw an "old age pension" when they reached 65 years of age.  The purpose was to help reduce poverty among America's aging population.  The original act provided for no disability benefit.

In 1955, Congress took note of hundreds of thousands of workers who became disabled prior to age 65 but had no disability insurance to help ease the hardship of lost wages.  A debate began concerning adding a disability benefit to Social Security.

THE PROBLEM:  Congress realized that the strained federal budget could not support another entitlement program paid for by federal dollars.  What they came up with was an entirely separate disability trust fund, not supported by federal tax dollars at all.  The trust fund would be supported by specific taxes on workers and their employers. Under the new Federal Insurance Contributions Act (FICA), each worker would have a percentage of his wages withheld and paid into the federal trust fund.  The employer would also be required to pay an equal or matching amount into the fund.  When a disability claim occurred, the benefit would be paid out of the trust fund, not out of the US treasury.  So, no treasury tax dollars would be spent.

THE SOLUTION: The Social Security Administration (SSA) collected money from workers, much the same way that a private insurance company would.  They pooled this money in a disability trust fund and distributed money to disabled beneficiaries, just like an insurance company would do. The difference between SSDI and private insurance is that SSDI withholding is mandatory (you can't avoid it), while paying private insurance premiums is optional (your choice).

WHAT YOU NEED TO GET DISABILITY BENEFITS

1.  You must have worked enough to accumulate the minimum quarters of coverage.  Most workers need 20 quarters of coverage accumulated during the past 10 years. Stated simply, you need to have worked at least 5 years out of the the past 10 years.

2.  You cannot be currently working at substantial gainful activity.  You cannot hold a substantial job and apply for SSDI at the same time.  A job is substantial if your gross earnings or self-employment income are at least $1,180 per month.

3.  You must have a medically determinable impairment that has (a) lasted for at least 12 consecutive months, (b) is expected to last for at least 12 consecutive months, OR (c) is expected to end in death.  This is called the duration requirement.

4.  Your medical impairment must be severe enough to prevent you from performing any full-time work activity, not just the job you are accustomed to or trained for.  (Rules are a bit different for persons over age 50).

A Final Thought    

Social Security denies over 70 percent of all disability claims--even some that meet the rules and should be paid. Mistakes are frequent. Nearly everyone who eventually gets a benefit must appeal their denied claim and appear before a US administrative law judge for a hearing.  Your chances at the hearing are much better, particularly if you have an experienced disability advocate who knows how to prepare and present you case to meet the federal rules.  So, the biggest mistake you can make is failing to appeal your denial, or waiting too long to file the appeal.  You must appeal within 60 days of the denial decision.  This is a strict deadline.
__________
by Charles W. Forsythe
Social Security Disability Representative
The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
Across from Bridge Street
PHONE US:  (256) 799-0297

EMAIL ME:    forsythefirm@gmail.com


SOCIAL SECURITY JUSTICE WEBSITE

FASTER TRACKS TO SOCIAL SECURITY DISABILITY

It's well known that disability claims in the Huntsville, AL are take up to 2 years.  Claims are usually denied at the first stage and require a hearing.  But there are certain circumstances that your attorney or advocate can use to speed up your claim and drastically cut wait times:

1)  Compassionate Allowance.  Social Security recognizes approximately 300 diseases that automatically qualify for SSDI or SSI benefits.  If you have one of these diseases, your attorney can ask for a compassionate allowance and get benefits approved right away.

2)  Dire Need.  If you can show that you can't pay your rent or mortgage and would be homeless without assistance, you might qualify for a faster dire need decision.  If you need urgent medical care that you cannot obtain, you might qualify for dire need consideration.  A dire need does not necessarily get you approved; it simply gets you a hearing much faster.

3)  On-the-Record (OTR) decision.  In some circumstances, your attorney or representative may ask a judge to make a review of your case on the record, meaning a documentary review without a hearing, and make a decision.  This can save several months off the process.  However, OTR decisions are not right for every case.

4)  Disabled Veterans with a 100 percent VA disability rating may qualify for expedited processing.  In some circumstances, this can cut the processing time in half, or it could even be faster than that.


Aside from one of these four circumstances, your representative can keep your case moving by completing applications and forms promptly and properly.

CHECKLIST FOR YOUR SSDI HEARING: HERE'S WHAT YOU NEED

So, you have waited two years or more and are finally scheduled to appear for your Social Security disability hearing.  You are understandably nervous and expectant.  For most people, this is their first appearance before a judge.

Prior to your hearing, there are things you need to prepare.  Here's a short checklist:

___ Be certain the judge has all of your pertinent medical records, including records of any recent treatment or hospitalization.  It is your responsibility to submit medical evidence.

___ Do you know the exact date you last worked?  The judge must ask.

___ Prepare a list of all prescription medications you take.

___ Have an answer for the question, "Why do you believe you are unable to work?"  Think in terms of symptoms, not just diseases.

___ Try to understand Social Security's definition of disability.  Note:  There is one definition for persons under 50, another for persons 50 and over.

___ Look at your "alleged onset date."  Why is this the appropriate date for the onset of your disability?  Be able to explain.

___  Try to formulate a "legal theory" of your case.  In other words, why do you meet the rules and regulations that define disability?

___ Be sure you understand the difference between unemployment and disability.  Unemployment means you can't find a job.  Disability means you are not able to perform the duties of a job.

___ Check out general Do's and Dont's:

• Avoid vague terms like sometimes, not very often, a little bit...
• Don't answer questions you don't understand; ask for clarification.
• Always answer questions truthfully.
• Remember, a voice recording will be made, so speak up.

__ Finally, ask yourself, "Do I really want to do this alone?" There is still time to consider getting legal representation. 

GRID RULES AND SOCIAL SECURITY DISABILITY

Sometimes, an individual can be quickly approved for disability benefits by use of the "grid rules."  What are grid rules and how are they helpful?

The so-called rules are officially the "medical-vocational guidelines" published in 20 CFR 404, Subpart P, Appendix 2.

The grids look at several factors in addition to your medical impairment to see if a finding of disability is directed by the published guidelines.  

The information is laid out in a table with 5 columns in a grid (hence the name, GRID RULES).

These rules can only be used for physical impairments.  If you have psychological impairments or non-exertional impairments, the rules don't apply. 

Also, these rules only apply to claimants who are at least 50 years old.  (Young individuals can get benefits, but not by using grids).

The following 5 things are considered by the grids:

• your age
• your education level
• the skill level of the work you did in the past 15 years
• whether you have learned any skills that can be used in a different job, and
• your residual functional capacity (RFC) – what you can do despite your impairments.

Here's an illustration of how we would apply the grid rules:

In column 1, John's residual functional capacity is limited to sedentary work.  In column 2, he is 55 years old, hence a person of "advanced age."  In column 3, John has a 9th grade education, considered a limited education.  In column 4, past work experience has been in an unskilled job, so there are no transferable skills.  Based on all of these factors, column 5 directs a decision of disability, based on Grid Rule 201.01.

CAUTION:  At the application level, decision makers tend to deny most applications.  Therefore, I suspect that John's claim would be denied at the first level of review.  He will probably still get a letter stating something like this:  "You are not eligible for disability benefits.  This is because you are not disabled according to our rules."

Why would they deny this claim?  Because the decision maker will not concede the fact that John is limited to sedentary work.  They will say he can perform light or medium work.  Since they set his Residual Functional Capacity too high, he won't meet a grid rule and a denial results.  About one-half of the applications that I see denied encounter this error.

John will need to appeal this denial within 60 days.  The appeal, if filed in time, will take his claim before an administrative law judge (ALJ) who will reevaluate his medical evidence and, hopefully, recognize his RFC as limited to sedentary work.  When this happens, John will meet the grid rule (201.01) and be awarded his benefits.

The chore for John's attorney will be to prove that his client is limited to sedentary exertion level, using medical evidence from John's doctors.  The attorney will quickly analyze the denial and see right away what the problem is.  He or she will also know immediately must happen to get the denial overturned at the hearing.

So, John's attorney will go into the hearing focused on the main problem.  The goal will be to use evidence to demonstrate that Grid Rule 201.01 will determine that John is disabled under Social Security's own rules and that he should be paid.

This is so much different than what would happen if the claimant just went to the hearing unrepresented and hoped for the best. Being unaware of Grid Rule 201.01, John would probably tell the judge the truth about his impairments--but fail to direct the case to its proper focal point--Rule 201.01, where his age, education, lack of skilled work and proper residual functional capacity would direct approval of benefits.

REPRESENTED BY COMPETENT COUNSEL:  John could be found disabled on his alleged onset date of 2/18/15.*  He will receive $37,604 in past due benefits and will get a check for $1,687 per month for as long as he is disabled.  He will also get Medicare insurance to pay for medical treatment.  He will pay his attorney-advocate a $6,000 fee, taking home $31,604 in past due benefits and all of his monthly award.

UNREPRESENTED:  John may be denied again.  If so, he will receive $0 back pay and $0 per month in benefits.  He would get no Medicare insurance.  Did he just save a $6,000 attorney's fee?  Well, that's not the way I would look at it!

You don't have to understand Social Security's complicated rules.  Just be sure you hire someone who does!
_____________
THE FORSYTHE FIRM
Social Security Disability Representation
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

FORSYTHE FIRM: SOCIAL SECURITY JUSTICE 


*All names used in this post are fictional so that no claimant's identity is compromised.  Numbers are reasonable representations of benefits that might apply, not actual numbers.  Having a representative does not guarantee that you will win your case because, obviously, some represented claimants also are denied.  But having adequate representation gives you a better chance for approval, especially at appeal.  This post is used for general information and not for legal advice on any particular situation.  Consult an attorney or Social Security representative about your case.